Suicidal ideation reported on the PHQ9 and risk of suicidal behavior across age groups

Abstract

Objective: The Joint Commission recommends all patients be screened for suicide. However, differences in suicide attempt and death rates may affect how well tools predict risk across age groups. Our objective was to determine whether item 9 of the Patient Health Questionnaire (PHQ9) predicts risk for suicide attempts and deaths across age groups.

Methods: PHQ9s completed by adult outpatients treated for mental health conditions in 2010-2012 at four Mental Health Research Network-affiliated healthcare systems were used to measure depression severity and suicidal ideation. Suicide attempts were identified via ICD-9 codes and suicide deaths via ICD-10 codes and state death certificates.

Results: In all, 939,268PHQ9s were completed by 297,290 outpatients. Compared to those without, those with nearly daily suicidal ideation were 5-to-8 times more likely to attempt suicide and 3-to-11times more likely to die by suicide within 30 days, and 2-to-4times more likely to attempt suicide and 2-to-6 times more likely to die by suicide within 365 days. The increased risk of suicide death for those with any level of suicidal ideation persisted over two years. The relationships between suicide thoughts and attempts and deaths were similar across age groups.

Limitations: Our sample was limited to outpatients completing a PHQ9 and relied on pre-existing clinical and administrative data.

Conclusions: Suicidal ideation reported on the PHQ9 was a robust predictor of suicide attempts and deaths regardless of age, and this increased risk persisted for two years. Healthcare systems should address both the immediate and sustained risk for suicide for patients of all ages.

Keywords: Depression; Suicide attempts; Suicide deaths.

Copyright © 2017 Elsevier B.V. All rights reserved.

Figures

FIGURE 1. Cumulative risk of suicide attempts in the days following PHQ9 completion, grouped by age

Question 9 of the PHQ9 asks about thoughts of being better off dead or of hurting oneself in some way over the last two weeks. Response options include “not at all,” “several days,” “more than half the days,” or “nearly every day”. Models adjusted for gender, healthcare system, patient mental health treatment status, visit type, Charlson score and race/ethnicity.

FIGURE 2. Cumulative risk of suicide deaths in the days following PHQ9 completion, grouped by age

Question 9 of the PHQ9 asks about thoughts of being better off dead or of hurting oneself in some way over the last two weeks. Response options include “not at all,” “several days,” “more than half the days,” or “nearly every day”. Models adjusted for gender, healthcare system, patient mental health treatment status, visit type, Charlson score and race/ethnicity.